As the name implies, First Responders are people who get to emergencies first. They get involved when situations are chaotic and dangerous. Lives are frequently in jeopardy. Failure to take action quickly and act effectively can have dire consequences. Included in the First Responder category are law enforcement personnel, firefighters, EMS personnel, communications officers, federal agents, Search and Rescue personnel, emergency and critical care nurses, disaster response personnel, medical doctors, especially in high risk environments like emergency and critical care centers and many members of the armed forces.
There are three terms that should come to mind when we think of First Responders:
High Intensity
High intensity work is fast-paced with one emergent situation often following closely on another. Sometimes multiple demanding situations are occurring simultaneously. On occasion, First Responders may work a scene of a major disaster. First Responders find that the stakes in their work are often very high. Mistakes and accidents are costly from many points of view. Mistakes in a field operation can delay final actions. The situation may spiral out of control. People can be seriously injured or they may die. The pressures for consistent maximum performance are great (Forstenzer, 1980; Hassling, 2000).
High Reliability
The term ‘High Reliability’ means that people in trouble can count on First Responders for help. They respond regardless of the weather or the circumstances or the threats. People who work in High reliability organizations cannot pick and choose which critical incidents they will handle. High Reliability organizations and the personnel who work for them have special training, specialized equipment, procedures or protocols. Substandard performance is unacceptable and dangerous. They are expected to function consistently and safely for the good of others.
High-Risk
Professions that are listed as high-risk are those whose members or employees experience considerable physical and psychological threats in their work. The word ‘members’ is used along with employees in the previous sentence because many people work as volunteers for high-risk organizations. Volunteer fire department personnel or volunteers who work at disaster sites for the Red Cross are examples of volunteer first responders who are exposed to some of the same physical and emotional threats as career employees. Rather than repeat, throughout this chapter, the fact that volunteers are involved in high-risk work, the words ‘personnel,’ ‘members,’ ‘first responders,’ ‘emergency services’ or ‘employees’ will be used somewhat interchangeably with the implication that both volunteers and career staff work as first responders.
This chapter is based on the premise that high-risk organizations are those in which the personnel face potential exposures to extreme stress or significant threats to their physical and emotional wellbeing. Highly stressful or threatening circumstances are viewed as a probable hazard associated with employment in these professions. Military and emergency services personnel such as law enforcement officers, fire fighters, search and rescue personnel, disaster workers, nurses, doctors and other medical staff are among the most well known psychologically high risk professions. They are not, however, the only professions in which there are considerable physical and emotional risks. The physical and psychological risks that are associated with mining, logging, ground transportation, aviation, and commercial fishing operations are well documented (Staff, Air Safety Week, 2001); Parker, 2006; US Department of Labor, 2008, a, b; 2009; Inglish, 2010).
Being on a list of high-risk professions should not be a badge of honor for any organization, agency or department. Risks must be managed and reduced wherever possible. The aim should always be high reliability, not maintaining the status quo of high-risk. These organizations must function reliably, consistently, effectively, and, above all else, safely.
As this chapter points out, one way to reduce and manage the psychological risk in First Responders is to develop peer support teams based on the principles of Critical Incident Stress Management.